Predictors for prolonged hospital stay solely to complete intravenous antifungal treatment in patients with candidemia: Results from the ECMM candida III multinational European observational cohort study

Egger, Matthias, Salmanton-García, Jon, Barac, Aleksandra, Gangneux, Jean-Pierre, Guegan, Hélène, Arsic-Arsenijevic, Valentina, Matos, Tadeja, Tomazin, Rok, Klimko, Nikolai, Bassetti, Matteo, Hammarström, Helena, Meijer, Eelco F. J., Meis, Jacques F., Prattes, Juergen, Krause, Robert, Resat Sipahi, Oguz, Scharmann, Ulrike, White, P. Lewis, Desoubeaux, Guillaume, García-Rodríguez, Julio, Garcia-Vidal, Carolina, Martín-Pérez, Sonia, Ruiz, Maite, Tumbarello, Mario, Talento, Alida Fe, Rogers, Benedict, Lagrou, Katrien, van Praet, Jens, Arikan-Akdagli, Sevtap, Arendrup, Maiken C., Koehler, Philipp, Cornely, Oliver A., Hoenigl, Martin, Alastruey-Izquierdo, Ana, de Jonge, Nick Alexander, Bicanic, Tihana, Blennow, Ola, Denis, Blandine, Khanna, Nina, Lass-Flörl, Cornelia, Logan, Clare, Loughlin, Laura, Özenci, Volkan, Zdenek, Zdenek, Rahimli, Laman, Rautemaa-Richardson, Riina, Steinmann, Joerg, Stoma, Igor, Trauth, Janina, Danion, François, Buil, Jochem B., Dávila-Valls, Julio and van Wijngaerden, Eric 2023. Predictors for prolonged hospital stay solely to complete intravenous antifungal treatment in patients with candidemia: Results from the ECMM candida III multinational European observational cohort study. Mycopathologia 188 (6) , pp. 983-994. 10.1007/s11046-023-00776-4

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Abstract

Background: To date, azoles represent the only viable option for oral treatment of invasive Candida infections, while rates of azole resistance among non-albicans Candida spp. continue to increase. The objective of this sub-analysis of the European multicenter observational cohort study Candida III was to describe demographical and clinical characteristics of the cohort requiring prolonged hospitalization solely to complete intravenous (iv) antifungal treatment (AF Tx). Methods: Each participating hospital (number of eligible hospitals per country determined by population size) included the first ~ 10 blood culture proven adult candidemia cases occurring consecutively after July 1st, 2018, and treating physicians answered the question on whether hospital stay was prolonged only for completion of intravenous antifungal therapy. Descriptive analyses as well as binary logistic regression was used to assess for predictors of prolonged hospitalization solely to complete iv AF Tx. Findings: Hospital stay was prolonged solely for the completion of iv AF Tx in 16% (100/621) of candidemia cases by a median of 16 days (IQR 8 – 28). In the multivariable model, initial echinocandin treatment was a positive predictor for prolonged hospitalization to complete iv AF Tx (aOR 2.87, 95% CI 1.55 – 5.32, p < 0.001), while (i) neutropenia, (ii) intensive care unit admission, (iii) catheter related candidemia, (iv) total parenteral nutrition, and (v) C. parapsilosis as causative pathogen were found to be negative predictors (aOR 0.22 – 0.45; p < 0.03). Interpretation: Hospital stays were prolonged due to need of iv AF Tx in 16% of patients with candidemia. Those patients were more likely to receive echinocandins as initial treatment and were less severely ill and less likely infected with C. parapsilosis.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Medicine
Publisher:	Springer
ISSN:	0301-486X
Date of First Compliant Deposit:	5 October 2023
Date of Acceptance:	11 July 2023
Last Modified:	15 Jan 2024 11:28
URI:	https://orca.cardiff.ac.uk/id/eprint/162978

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